Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Sunday, April 15, 2012

Shaping Doctors for Health Care That Won’t Exist

This morning’s New York Times examines the Association of American Medical Colleges’ (AAMC) answer to restoring the “heart and soul” of medicine by adding social sciences pre-requisites to the Medical College Admission Test (MCAT).

“Yes, we’ve fallen in love with technology, and patients are crying out, saying, ‘Sit down and listen to me,’ ” said Dr. Charles Hatem, a professor at HarvardMedicalSchool and an expert in medical education.

While I’m the first one to support a patient-centric approach to health care, why would the AAMC prepare their medical students for a health care world that will not exist?Are we not pretending and misleading our future physicians with such a pre-requisite for medical school admission?

The AAMC’s has a responsibility to prepare their students for the realities of today’s physician. Developing selection criteria for medical school based on social and humanitarian coursework without addressing the reality of today’s increasingly computer-screen-focused medical practice is whistling in the dark. As it is developing today, they would be more effective by preparing their students with typing lessons and pre-selecting them for unflagging conformity and rule-following skills.

In my experience, most medical students and fellows today have no idea of the looming threat that exists to practicing medicine in the way they imagine it.If the AAMC is truly concerned about patient-centric medicine, they would promote student activism to participate in policy changes that insist on more patient contact.But as it stands now, the idea that the inclusion of these social science pre-requisites to the MCAT is like dancing while Rome burns.

7 comments:

I dunno Wes. Looking back with the sharpness of hindsight, I would have loved to have had forced on me, some humanities and social science. Think of the vocab that could be unleashed on the blog-o-sphere, the references, the erudition. Now I have to Google, Wikpedia and otherwise look that stuff up just to sound smart.

On a serious note, conformity is so in vogue right now. That it is, hurts my heart too.

There's lots of other courses I wish I could have taken in the past, too, John, but would this have made you more compassionate with your patients?

Unlikely.

At the issue here is whether the addition of social sciences pre-requisites to the MCAT will select and engender a more compassionate physician that spends more time with their patients.

In this piece I argue that the the AAMC’s new MCAT requirement (and the time/cost that it requires for new med school applicants) is incongruous to the new world order of medicine that continues to strip physicians of their autonomy and insists on making them little more than data-entry personnel who follow proscribed quality and treatment rubrics while diminishing time with patients.

We can only hope that the pendulum will swing back toward the patient rather than the computer, mandates, and proscribed care, but as cost-, volume-, and time-constraints add more and more pressure to doctors in our highly regulated environment, the prognosis for a more empathetic physician is poor.

On the other hand, if our new generation of physicians were armed with organizational skills and a realistic understanding of the forces working against the doctor-patient relationship, they might garner the skills necessary to improve the system. This, to me, is where the AAMC should better equip tomorrow's med school applicants, rather than piling on more expensive (and meaningless) course pre-requisites that are out of touch with tomorrow’s health care environment.

Everything about the structure of medicine suggests that we actually do not value contact with the patient. Some of the best compensated specialties have absolutely no contact with patients whatsoever. Those that have the most contact (primary care fields) earn half what these specialities make. What message does this send to new grads?!

I fully agree that we should stop paying lip service to these grand ideas of patient centered medicine and other mantras of supposed change. As we all become slaves to data entry, the humanitarian features of medicine are simply being crowded out of the picture. Besides, what proof does the MCAT have that high acheivemnt on the humanities and social scince part of the test breeds more compassionate doctors? I suspect none.

This post has finally inspired me to write a question I've delayed asking for a while.

Many of your posts warn aspiring pre-meds (such as myself) about the bureaucratization of medicine. This trend of creating more and more rules -- all in the name of improving patient care (and simultaneously reducing cost!) -- is dehumanizing.

Paul Starr has written this trend of corporatization has been in the works for decades, but it appears to many we are currently hitting a tipping point. Regardless of whatever happens with the mandate, medicine has entered a new era to be dominated by checklists, rules, and incentives. Hence, I am concerned that following through on my dream to become a physician may be a spectacularly poor LIFE choice (members of my immediate family are physicians so I'm aware it is a way of life). Currently, I work as an instructor and I happen to be blessed with open-minded managers that have allowed me an unprecedented degree of autonomy with respect to designing my course (I teach physics, chemistry, and biology). Thus, I am currently enjoying tremendous pleasure OUTSIDE the classroom as well as INSIDE the classroom.

My dream, however, is to become a physician (with some luck, an attending so that I could continue teaching), yet a small part of me fears that by the time I have finished my training (let's say 2023), physician autonomy will become so eroded that I will find myself frustrated and demoralized. When those moments of doubt occur, I find ways to inspire myself (such as running back to re-read your post as top ten reasons to become a doctor!). And yet I still feel compelled to seek re-assurance: How risky (in terms of happiness and demoralization, not dollars and cents) is it to pursue a career in medicine?

I look forward to your response as well as the responses from other physicians and med students.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.